Virtual School Counselor Request Form

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Lincoln School Counselors, Mrs. Winfrey and Mr. Chambers, are available to meet with students and families through Zoom, Google Hangouts, or phone that request a time to check in through this form. Email is also an available method to make contact. The School Counselors are available are Monday-Friday from 9am-4pm, and during "off" hours depending on availability. Please fill out the information below and a school counselor will be in touch as soon as possible to confirm a day/time.

NOTE: If this is a big problem/emergency, exit this form and talk to the nearest adult you trust or call Southwest Washington Crisis Line at 800.626.8137

For emergency situations requiring immediate on scene response, dial 9-1-1

Email *

Today's Date *

YYYY

I would like to check in with: *

Mrs. Winfrey

Mr. Chambers

Whoever is available

Required

Preferred form of communication *

Zoom video

Canvas message

Phone

Other:

What is the best time of day to reach you? *

Are you a... *

Parent/Guardian

Student

Other:

Last Name *

First Name *

Size of the problem *

No problem really, just wanted to say hi!

Small problem

A medium problem (Need to vent or talk it out)

Big problem/Emergency. Please exit form and talk to the nearest safe adult.

What do you need help with? *

My Feelings

Friend Stuff

Other Kids

Family

Schoolwork

My Choices

Other:

Describe the problem (Optional)

Submit

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